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[Perforation in Crohn's ileitis and its impact on the natural history of the disease. Note 1. Pathogenic process of the event, its relationship with intestinal obstruction, and its immediate consequences].

The pathogenesis and consequences of perforation in Crohn's disease were studied in 175 patients submitted to surgery. Perforation occurred in 40 (23%) patients with ileitis or ileocolitis, always in the terminal ileum; so-called "free" perforation occurred in 1 patient, "limited" perforation in all the others. Perforation is always a consequence of a chronic intestinal obstruction caused by the stricture of the terminal ileum, which becomes absolute because of the blocking by solid intestinal content. It occurs in the borderline between the stricture and proximal dilated loop, where the fissures (typical of Crohn's ileitis) are stretched to the utmost and dilated by the hyperpressure and distension of the wall following ileal stenosis. Perforation in the peritoneal cavity is always free; its consequence is usually not a diffuse septic peritonitis but an abscess, because only a small amount of intestinal content leaks out. This happens because in the proximal occluded bowel, pressure decreases abruptly following the spilling of intestinal content, particularly of gas. The abscess fed by intestinal content enlarges and finally opens into a hollow organ or onto the skin, causing a fistula (internal or external). The rational therapeutic approach to perforation and its consequences (the infrequent diffuse septic peritonitis, or the more common abscesses and fistulas) is always and only ileal stenosis removal.

Crohn Disease↗
PubMed2000

Adynamic ileus after caesarean section mimicking intestinal obstruction: findings on abdominal radiographs.

The purpose of this study was to determine the spectrum of findings and the frequency of apparent distal colonic obstruction on abdominal radiographs in women with obstructive symptoms following Caesarean section. A search of radiology files yielded 21 patients who had abdominal radiographs because of obstructive symptoms during the early post-operative period. The radiographs were reviewed retrospectively to characterize the bowel gas patterns in these patients. Medical records were also reviewed to determine the treatment and patient course. Abdominal radiographs showed findings suggestive of distal colonic obstruction in 15 patients (71%), small bowel obstruction in 2 (10%), adynamic ileus in 3 (14%) and a normal bowel gas pattern in 1 (5%). In all 15 patients with apparent distal colonic obstruction, there was minimal or no gas in the rectosigmoid, with an associated pelvic mass representing the enlarged post-partum uterus, which compressed the rectosigmoid and prevented it from filling with gas. All 21 patients had rapid clinical or radiographic improvement on conservative management, indicating a transient post-operative ileus. Radiologists should be aware of the limitations of abdominal plain radiographs following Caesarean section so that a post-operative ileus is not mistaken for a distal colonic obstruction and conservative measures can be undertaken to decompress the bowel until the ileus resolves.

Adult↗
PubMed1980

Preduodenal portal vein--a cause of intestinal obstruction?

A preduodenal position of the portal vein is a rare anomaly reported in 52 cases in the literature. Two additional cases are reported here. In 54% of the cases of preduodenal portal vein (PPV) was combined with high intestinal obstruction and in one half of these cases PPV was considered obstructive. A critical review of these cases given the impression that obstructive PPV could well be a misinterpretation of the obstructive situation and the existence of obstructive PPV is doubted.

Duodenal Obstruction↗